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Allogeneic bone marrow transplant recipients (BMT) are at
high risk of developing invasive fungal infections by Candida species. Invasive
Candida infections are of endogenous origin, developing from gastrointestinal
colonization. A majority of BMT patients are colonized before and during the
transplant proceedure.
Material & Methods: We performed a pilot trial
with bovine anti-Candida-antibodies derived from the colostrum of cows
immunized against Candida mannan antigen. Nineteen patients were first followed
to evalauate the colonization pattern by quantitative fungal cultures in
specimens from the mouth, urine and feaces. Patients with more than 100 CFU/ml
of Candida in saliva before BMT had a stable or increasing colonization rate
during BMT and 11 patients of these rate were studied. One patient was later
excluded due to systemic antifungal therapy for a suspected invasive fungal
infection. Antibody treatment consisted of 10 g of bovine anti-Candida
antibodies containing 4.2 g of IgG, divided into 3 daily doses from day 4
before transplantation up to day 28 after BMT. The product was administered
orally as a swish and swallow formula dispersed in chocolate drink. All
patients also received topical nystatin (0.8 x 106U/day). Patients
were followed by quantitative mouth wash cultures twicw weekly during the
study, stool as well as serum samples were collected and analysed for any
remaining bovine protein.
Results: Evaluation of the colonization revealed that
48 % of BMT recipients were colonised with Candida pre-BMT and the rate
increased to 72 % beeing colonized at some time during BMT. The majority of
fungal isolates were Candida albicans. Compliance was a problem due to severe
mucositis and the patients could take antibodies for a median of 6 out of 33
days ( range 2 - 28 days). Response was seen in 7 out of 10 patients that
recieved antibodies, with a reduction of CFU:s during therapy and 1 patient
became completely negative during therapy. No adverse events were noted, some
undigested or partly digested bovine proteins could be found in stool samples
and only minute amounts could be found in serum samples.
Conclusion: A pilot trial with topical bovine
anti-Candida-antibodies as oral colonization prophylaxis revealed favourable
results, reducing colonization rate in 7 /10 patients and a complete
erradication in 1 patient. Thus encouring further larger studies to evaluate
the prophylactic possibility in immunosuppressed patients.